New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality
Top Cited Papers
Open Access
- 18 May 2009
- Vol. 64 (12), 1062-1069
- https://doi.org/10.1136/thx.2008.109785
Abstract
Background: The database of the German programme for quality in healthcare including data of every hospitalised patient with community-acquired pneumonia (CAP) during a 2-year period (n = 388 406 patients in 2005 and 2006) was analysed. Methods: End points of the analysis were: (1) incidence; (2) outcome; (3) performance of the CRB-65 (C, mental confusion; R, respiratory rate ⩾30/min; B, systolic blood pressure Results: The incidence of hospitalised CAP was 2.75 and 2.96 per 1000 inhabitants/year in 2005 and 2006, respectively, higher for males (3.21 vs 2.52), and strongly age related, with an incidence of 7.65 per 1000 inhabitants/year in patients aged ⩾60 years over 2 years. Mortality (13.72% and 14.44%) was higher than reported in previous studies. The CRB-65 RCs accurately predicted death in a three-class pattern (mortality 2.40% in CRB-65 RC 1, 13.43% in CRB-65 RC 2 and 34.39% in CRB-65 RC 3). The first days after admission were consistently associated with the highest risk of death throughout all risk classes. Only a minority of patients who died had received mechanical ventilation during hospitalisation (15.74%). Conclusions: Hospitalised CAP basically is a condition of the elderly associated with a higher mortality than previously reported. It bears a considerable risk of early mortality, even in low risk patients. CRB-65 is a simple and powerful tool for the assessment of CAP severity. Hospitalised CAP is a frequent terminal event in chronic debilitated patients, and a limitation of treatment escalation is frequently applied.This publication has 32 references indexed in Scilit:
- Health Care-Associated Pneumonia and Community-Acquired Pneumonia: a Single-Center ExperienceAntimicrobial Agents and Chemotherapy, 2007
- Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in AdultsClinical Infectious Diseases, 2007
- Reducing door-to-antibiotic time in community-acquired pneumonia: controlled before-and-after evaluation and cost-effectiveness analysisThorax, 2007
- Assessment of pneumonia severity: a European perspectiveEuropean Respiratory Journal, 2006
- Validation of a predictive rule for the management of community-acquired pneumoniaEuropean Respiratory Journal, 2006
- Combining information from prognostic scoring tools for CAP: an American view on how to get the best of all worldsEuropean Respiratory Journal, 2006
- S3-guideline on Ambulant Acquired Pneumonia and Deep Airway InfectionsPneumologie, 2005
- Validation of predictive rules and indices of severity for community acquired pneumoniaThorax, 2004
- Etiology, Reasons for Hospitalization, Risk Classes, and Outcomes of Community‐Acquired Pneumonia in Patients Hospitalized on the Basis of Conventional Admission CriteriaClinical Infectious Diseases, 2001
- Do smoking parents seek the best advice for their asthmatic children?Thorax, 2001